tianjin first center hospital lu chengzhi guo qianyu chen xin...
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Thrombus Aspiration and Sequential Stenting in Bilateral Carotid Arteries for a Patient with Takayasu Arteritis. Tianjin First Center Hospital Lu Chengzhi Guo qianyu Chen xin 天津市第一中心医院心内科 卢成志 郭倩玉 陈欣. History. Female , 36 years old - PowerPoint PPT PresentationTRANSCRIPT
Thrombus Aspiration and Sequential Thrombus Aspiration and Sequential Stenting in Bilateral Carotid Arteries Stenting in Bilateral Carotid Arteries
for a Patient with Takayasu Arteritisfor a Patient with Takayasu Arteritis
Tianjin First Center Hospital Tianjin First Center Hospital
Lu Chengzhi Guo qianyu Chen xinLu Chengzhi Guo qianyu Chen xin
天津市第一中心医院心内科天津市第一中心医院心内科卢成志 郭倩玉 陈欣卢成志 郭倩玉 陈欣
HistoryHistory
FemaleFemale ,, 36 years old36 years old
Chief complaint: intermittent amaurosis for Chief complaint: intermittent amaurosis for one month, arose from exertion, one month, arose from exertion, accompanied with tumbling accompanied with tumbling
Past history: Takayasu arteritis and Past history: Takayasu arteritis and pulmonary fibrosis for 3 years under oral pulmonary fibrosis for 3 years under oral prednisone managementprednisone management
Physical ExaminationPhysical Examination
RUE/LUE pulseless, LLE pressure 170/80 RUE/LUE pulseless, LLE pressure 170/80 mmHg, RLE pressure 130/80 mmHgmmHg, RLE pressure 130/80 mmHg
III/6 systolic murmurs in left carotid artery. III/6 systolic murmurs in left carotid artery. Both lung clear. HR 72 bpmBoth lung clear. HR 72 bpm ,, regular regular rhythm, no murmurs.rhythm, no murmurs.
Laboratory InvestigationsLaboratory Investigations
Blood RtBlood Rt :: Hb 110g/L WBC6.1X10Hb 110g/L WBC6.1X109/L9/L
Liver function and renal function: normalLiver function and renal function: normal TC 6.31mmol/L TG 1.64mmol/LTC 6.31mmol/L TG 1.64mmol/LESRESR :: 18mm/h18mm/hCRPCRP : : 0.76mg/dl 0.76mg/dl Immune antibodiesImmune antibodies ::
SSB(+)SSB(+) SSA(+)SSA(+) ANA: 1ANA: 1 :: 100100 others:(-)others:(-)
Angiography ExaminationAngiography Examination
CAGCAG :: 40% stenosis in LM ostium40% stenosis in LM ostium LAD normalLAD normal LCX normalLCX normal RCA normalRCA normal
Ceberal angiography:Ceberal angiography: :: Brachiocephalic trunk occlusive.Brachiocephalic trunk occlusive. Left carotid artery subtotal occlusive.Left carotid artery subtotal occlusive. Left subclavian artery: 90% stenosisLeft subclavian artery: 90% stenosis left vertebral artery: 95% stenosis in ostiumleft vertebral artery: 95% stenosis in ostium
Brachiocephalic trunk occlusiveBrachiocephalic trunk occlusive
Left carotid artery subtotal occlusiveLeft carotid artery subtotal occlusive
Left subclavian artery: 90% stenosisLeft subclavian artery: 90% stenosisleft vertebral artery: 95% stenosis in ostiumleft vertebral artery: 95% stenosis in ostium
Treatment strategyTreatment strategy
Conservative therapy?Conservative therapy?
Interventional therapy?Interventional therapy?
Carotidendarterectomy? Carotidendarterectomy?
Treatment strategyTreatment strategy
MedicationMedication :: prednisone prednisone cyclophophamidecyclophophamide
Interventional therapyInterventional therapy :: first step: stent in right carotid arteryfirst step: stent in right carotid artery second step: stent in left carotid arterysecond step: stent in left carotid artery
Stenting in right carotid arteryStenting in right carotid artery (( 2009-05-252009-05-25 ))
ApproachApproach :: right femoral arteryright femoral arteryEquipmentEquipment ::
8F MPA1 Guiding catheter8F MPA1 Guiding catheter guide wireguide wire distal end protective umbrelladistal end protective umbrella 2.0×20mm×mm Avion balloon2.0×20mm×mm Avion balloon thrombus aspiration catheter thrombus aspiration catheter 5.0×40mm Submarine balloon5.0×40mm Submarine balloon 7.0×40mm Precise stent7.0×40mm Precise stent
Postoperative treatmentPostoperative treatment
Aspirin 300 mg and clopidogrel 75 mgAspirin 300 mg and clopidogrel 75 mg
Nifedipine to control BPNifedipine to control BP
PrednisonePrednisone
The patient’s ESR rose transiently and The patient’s ESR rose transiently and then fell normal, she didn’t feel dizziness then fell normal, she didn’t feel dizziness or amaurosis any more. or amaurosis any more.
Stenting in left carotid arteryStenting in left carotid artery (( 2009-06-222009-06-22 ))
ApproachApproach :: right femoral arteryright femoral arteryEquipmentEquipment ::
8F MPA1 Guiding catheter8F MPA1 Guiding catheter 2 guide wire2 guide wire 2.0×20mm×mm Invatec balloon2.0×20mm×mm Invatec balloon distal end protective umbrelladistal end protective umbrella 5.0×30mm Invatec balloon5.0×30mm Invatec balloon 7.0×40mm Cordis stent7.0×40mm Cordis stent
5.0×30mm Invatec balloon5.0×30mm Invatec balloon 7.0×40mm Cordis stent7.0×40mm Cordis stent Final result
DiscussionDiscussion
Endovascular interventional therapy:Endovascular interventional therapy: an approach to an approach to occlusive lesion of arteritis: Is it a suitable option?occlusive lesion of arteritis: Is it a suitable option?
Thrombus aspirationThrombus aspiration: the first attempt dealing with : the first attempt dealing with thrombotic complications of stenting in carotid: Is it a thrombotic complications of stenting in carotid: Is it a lucky hit or a mandatory practice?lucky hit or a mandatory practice?
medication or stenting in subclavian arterymedication or stenting in subclavian artery: Is it done or : Is it done or overdone?overdone?
Antiplatlete therapyAntiplatlete therapy: duration and dosage.: duration and dosage.
Follow upFollow up
No dizzness or amaurosis until now No dizzness or amaurosis until now ESR 15-25 mmESR 15-25 mmMedication: Medication:
prednisone 5 mg QDprednisone 5 mg QD Aspirin 100 mg Aspirin 100 mg clopidogrel 75 mg QD for 6 Months clopidogrel 75 mg QD for 6 Months
8 month later CTA examination8 month later CTA examination
DiscussionDiscussion
What to do with restenosis now: What to do with restenosis now:
Intervention: bilateral balloon dilation?Intervention: bilateral balloon dilation?
Conservative treatment?Conservative treatment?
Carotidendarterectomy? Carotidendarterectomy?